Canada
As Canada has a HIV prevalence rate of just 0.2%, it does have to worry much about AIDS. The pandemic is only present in Canada at a very small scale & hence has no significant impact on labour supply or its growth rate. People are healthy & do not have to take frequent leaves from jobs to care for relatives infected with AIDS or lose their job for being tested positive for HIV. Public spending is focused on diseases like cancer, Alzheimer’s, heart-related diseases, etc.
2] Impact on Healthcare
South Africa
The HIV/AIDS pandemic poses tremendous challenges to the healthcare system of South Africa, where 21.5% of the population is infected with HIV/AIDS. The disease often claims the lives of doctors & nurses, creating a shortage of health workers: the World Bank estimates that 3-7% of its health workers are lost due to the AIDS pandemic; studies conducted in S. A. between 1991 & 1998 documented a five-fold increase in the tuberculosis rate among the staff.
Furthermore, the high demand for an effective treatment of AIDS makes it difficult to satisfy the demands for treatment of other diseases like malaria, cancer, tuberculosis, etc.
India
As India is a large country, with roughly 30% in urban areas, it is very difficult to provide medical facilities to people in the rural areas. In fact, many people living in villages have to walk miles to access a water pump, & carry them back in pots to their house. The lack of infrastructure (hospitals, clinics, doctors) & inaccessibility worsens scenario for HIV/AIDS victims in rural India. Public hospitals in urban areas do NOT offer quality healthcare & while private hospitals are much better, they are not affordable to the general public (average middle class family).
Canada
Canada has the highest average life expectancy out of all these three countries, that of 80 years. Hence, it has a much larger population aged of 65+, & this large ageing pop.n comes with its own problems. As people in MEDCs lead a healthy life, this section of the pop.n often faces health issues like lung cancer, heart disease, etc (as shown in the table to the right) due to excessive smoking which was a trend during their youth - the 1960s-1980s. Thus, a higher proportion of the deaths in Canada are due to heart disease (20%) & lung cancer (8%) allocating a greater portion of the health budget to research & treatment of such diseases rather than HIV/AIDS.
3] Impact on Households: financial crisis & changes in family structure
South Africa
A study shows that nearly 80% of AIDS victims were the family breadwinners, & 60% lost their jobs during their illness. Also, 1/7 caregivers gave up a job to care for the sick person. This leads to a loss of income & when they die, the temporary loss becomes permanent. Costs of AIDS like medical expenditures, hospital bills, funeral costs, mourning & other costs are usually paid for through the family’s savings or by selling off assets. Funerals keep family members home & their absence from work leads to a further decrease in income & increase in expenditures. Such mounting of expenditures often impoverishes households, pushing middle-class families below the poverty line & making poor people even poorer.
Death of the economically, or rather, sexually active group sees a gradual disappearance of the parental generation leaving children to be cared for by grandparents/ relatives. This leads to an imbalance in the average & overall family structure in the country. Loss of parents also burdens children as they now have to care & earn for themselves. According to recent studies, only 60% of children aged 10-14 who lost both parents attended school, compared to 77% of those with both parents still alive.
India
Since the majority of the HIV/AIDS victims are truck drivers & sex workers, there is a comparatively higher correlation between poverty, literacy & prevalence of HIV/AIDS. For people already living in poverty, further income loss can threaten their ability to meet basic needs such as food.
As child labour has since long been a problem in India, HIV/AIDS only pushes it further, undoing all the recent work of NGOs & govt policies against child labour. The same phenomena as mentioned above is taking place in India, where children in rural areas as well as poor urban areas drop out of school & take up full time jobs to support their family.
Canada
Since HIV/AIDS is transmitted mainly through drug users, & most of them are youngsters, there is no ‘gap’ in generations created. Healthcare is insured by the govt itself & hence is free or rather cheap to all. On an overall basis, there is no change in family structure.
4] Socio-cultural impacts, discrimination & stigma
South Africa
HIV, in South Africa, is considered a disease of the poor; a mild correlation exists between extreme poverty & high HIV prevalence, although HIV is prevalent across all sectors of society. Coming out as HIV-positive can have a negative effect on employment & housing opportunities, as well as social relationships. In December 1998, Gugu Dlamini, an AIDS activist, was beaten to death after declaring that she was HIV-positive on World AIDS Day. Since Africa, as a whole, is a male-dominant society, women are often unable to negotiate safer sex & frequently involved with men who have several sexual partners. They are also particularly vulnerable to sexual abuse & rape. In a 2006 study of 1,370 South African men, nearly one fifth revealed that they had raped a woman. Rape plays a significant role in the high prevalence of HIV among women in South Africa.
India
People living with HIV have faced violent attacks; been rejected by families/ spouses/ communities; been refused medical treatment; & even, in some reported cases, denied the last rites before they die. Discrimination is also alarmingly common in the health care sector. Negative attitudes from health care staff have generated anxiety & fear among many people living with HIV/AIDS, forcing them to keep their status secret. It is not surprising that among a majority of HIV positive people, AIDS-related fear & anxiety, & at times denial of their HIV status, can be traced to traumatic experiences in health care settings. A 2006 study found that 25% of HIV-positive people in India had been refused medical treatment on the basis of their status. It also found strong evidence of stigma in the workplace, with 74% of employees not disclosing their status to their employers for fear of discrimination. Of the 26% who did disclose their status, 10% reported having faced prejudice as a result.
Canada
As 99% of the population in Canada is literate, there are no misconceptions, discrimination & stigma prevalent there. Hence, people are neither ashamed/ shy of purchasing contraceptives nor of approaching health workers regarding HIV/AIDS related issues. Sex-ed is taught in school as a part of the syllabus & this ensures the young generation learns of it as well.
6] Preventive Measures for Mitigation of Impact of AIDS
Canada
Although Canada’s HIV prevalence rate has remained stable at 0.2%, its death rate is reducing & life expectancy increasing further as a result of better healthcare, improving pension schemes, high literacy rate & medical advances. The govt is constantly increasing awareness of HIV/AIDS & new contraceptive measures through campaigns & sex-ed in schools. The govt, along with those of many other countries, is also experimenting with new HIV vaccines to reduce the number of new cases each year. Access to contraceptives is easy & there are no social taboos or religious restricting forbidding its use; Canada enjoys a contraceptive prevalence rate of 75%, which is definitely among the highest in the world.
India
Having about 70% of its population in rural areas, India has to really work to firstly get rid of social taboos in society forbidding birth control & also spread awareness of HIV/AIDS, its consequences, & preventive measures. Furthermore, language is another barrier too – as each region has its own local language. This means that most of the effort for prevention of HIV/AIDS has to be done at a state or local level, rather than a nation-wide scheme.
Moving on to what is going on to mitigate effects, state AIDS control societies were granted funding for youth campaigns, blood safety checks, & HIV testing among other things. Awareness of the epidemic is being spread though concerts, radio dramas, a voluntary blood donation day & TV spots with a popular Indian film-star. Messages were also conveyed to young people through schools. Teachers & peer educators were trained to teach about the subject, & students were educated through active learning sessions, including debates & role-playing.
The next campaign of the govt is focused on promoting the use of condoms, successfully installing 100,000 condom vending machines in colleges, road-side restaurants, railway stations, gas stations & hospitals, etc. In one unique scheme, NGOs in West Bengal attempted promoting condom use through kite flying, a popular festival in the whole of India. Such initiatives are examples of best suited these localized schemes & prevention campaigns of HIV can be in India. In doing so, they can make an important impact, particularly in rural areas where information is often lacking. Small-scale campaigns like this are often run or supported by non-governmental organisations, which play a vital role in preventing infections throughout India, particularly among high-risk groups.
South Africa
Although South Africa has the highest AIDS prevalence rate in the world, the government has been condemned on several occasions for its lack of activity as far as the AIDS pandemic is concerned. Much of this criticism has focused on the lack of access to antiretroviral treatment across the country. The government has also been condemned for failing to provide drugs that could prevent mother-to-child-transmission of HIV.
The government has always maintained that the provision of antiretroviral drugs is not necessarily the best way to prevent the spread of the disease. Instead, the use of alternative ‘vitamins’ which will curb the spread of HIV within the body is constantly being promoted. Around 80% of people living in African countries consult traditional African healers & use traditional African remedies, even if they use conventional medicines as well. HIV voluntary counselling & testing (VCT) should be an important part of any country’s response to AIDS. The number of VCT sites in South Africa has increased significantly in recent years, with 4,172 operational by November 2006.
Several campaigns operate through telephone lines, clinics, pamphlets & youth centres where they provide as much information & medical care as they can.
Various social factors make it difficult to carry out effective HIV prevention campaigns in South Africa, as the population is highly diverse & divided by deeply rooted social inequalities. South Africans have a mixture of ethnic backgrounds. There are 11 official languages & many dialects; around 86% of the population is literate. Some live in large, crowded cities, while others live in sparsely populated rural areas, many of which are isolated, underdeveloped & lacking infrastructure. This diversity has made it very difficult to carry out AIDS awareness campaigns that actually influence people’s behaviour.
Conclusion
The three countries investigated had varying reactions to the epidemic as each of them were affected at a different scale & the development of the country & its progress also mattered in how effective the impact was. South Africa is struggling with its campaigns and is in desperate need for international aid while India is much better off localizing & delegating its campaigns to individual states rather than taking up a nation-wide mass media approach in order to respond effectively to each area’s beliefs & social taboos. Canada, the best off out of all three, is doing really well as it doesn’t have to bother much but yet take care and try to reduce the prevalence of HIV/AIDS in the country.
Credits
– The World Factbook
- Ecosoc division
– HIV/AIDS in South Africa
The POLICY Project - The Economic Impact of AIDS
The Washington Quarterly - India at the Crossroads: Battling the HIV/AIDS Pandemic
Collaborated with Gayatri Bhatia & Amandip Singh.
